Serum Ferritin versus C-Reactive Protein in Predicting Outcome and Mortality in Corona Virus Disease 2019 (Covid-19) A Retrospective Observational Study

Abstract Background In coronavirus disease 2019 (COVID-19), finding sensitive biomarkers is critical for detecting severe cases early and intervening effectively. Very few studies evaluated how ferritin and CRP are altered in COVID-19. Therefore, it is of clinical significance to evaluate the disease severity and investigate ferritin and CRP in patients with COVID-19. Objective To explore the infection biomarkers, including ferritin and CRP in ICU patients with COVID-19. We will aim to describe the clinical characteristics of infection markers in patients with COVID-19. Patients and Methods After approval of anesthesiology department and scientific and ethical committees, this retrospective observational study was carried out on 105 consecutive patients with confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units during a 6-month period from January 2020 to July 2020; divided into 2 groups; severe and critically ill cases. Results As regards the follow-up laboratory data, there was a significant increase in follow-up CRP, ferritin, D-dimer and PTT in critical group; compared to severe group. Our study showed that there was a highly significant difference between the 2 groups as regards the need of mechanical ventilation and mortality rate, as 68.3% of critical cases need mechanical ventilation and 58.5% died. As regard the length of stay in the ICU, the critical group had longer stay in the ICU in comparison to the severe group, although this difference was not statistically significant. Conclusion High baseline and follow up laboratory tests of CRP and serum ferritin both can be used as a predictor of outcome and mortality in COVID 19 infection. There is significant positive correlation between age, CRP and duration of stay in the ICU. Also there was a significant positive correlation between CRP, ferritin and duration of stay in the ICU. The increase in age and CRP; had an independent effect on increasing ICU stay. Increase in CRP levels; had an independent effect on increasing the probability of severity of COVID-19 infection. While ferritin shows a significant effect on increasing the probability of severity of COVID-19 infection in univariate analysis. Ferritin level at a cut-off point (>598) predict mortality outcome, with good (89%) accuracy, sensitivity (93.8%) and specificity (42.9%). Also, CRP level at cut-off point (>25) predict mortality outcome, with lower (80%) accuracy, sensitivity (87%) and specificity (33.3%).